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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health E Safety Code 4 25180.7 <br /> A. EMERGENCY LEVEL II III Health District Log N 5i7Z S 7 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: ( T <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): Time: -iK, <br /> Location: 325tZ <br /> — <br /> (Best Physi'al DescriptT—o—n)-7 (City or CountyT <br /> D. RESPONSIBLE PERSON/BUSINEESS <br /> Name of Business: <br /> Contact Person: Telephone: ( rj8 <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN Aa <br />